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      Patient Navigation to Enhance Access to Care for Underserved Patients with a Suspicion or Diagnosis of Cancer

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          Abstract

          Innovative strategies aimed at achieving timely referrals for patients with cancer, particularly those with limited resources, are needed. One such strategy is patient navigation (PN), which is a coordinated process of assistance that helps patients overcome personal and system barriers to obtain timely care. This article reports the results of a study designed to evaluate an evidence‐based and culturally sensitive PN program aimed at reducing the time to referral to a cancer center for patients with a suspicion or a diagnosis of cancer seen at a public general hospital in Mexico. Interventions aimed at improving access to timely cancer care for patients in low‐ and middle‐income countries (LMIC) are urgently needed. We aimed to evaluate a patient navigation (PN) program to reduce referral time to cancer centers for underserved patients with a suspicion or diagnosis of cancer at a public general hospital in Mexico City. From January 2016 to March 2017, consecutive patients aged >18 years with a suspicion or diagnosis of cancer seen at Ajusco Medio General Hospital in Mexico City who required referral to a specialized center for diagnosis or treatment were enrolled. A patient navigator assisted patients with scheduling, completing paperwork, obtaining results in a timely manner, transportation, and addressing other barriers to care. The primary outcome was the proportion of patients who obtained a specialized consultation at a cancer center within the first 3 months after enrollment. Seventy patients (median age 54, range 19–85) participated in this study. Ninety‐six percent ( n = 67) identified >1 barrier to cancer care access. The most commonly reported barriers to health care access were financial burden ( n = 50) and fear ( n = 37). Median time to referral was 7 days (range 0–49), and time to specialist appointment was 27 days (range 1–97). Ninety‐one percent of patients successfully obtained appointments at cancer centers in <3 months. Implementing PN in LMIC is feasible, and may lead to shortened referral times for specialized cancer care by helping overcome barriers to health care access among underserved patients. A patient navigation program for patients with suspicion or diagnosis of cancer in a second‐level hospital was feasible and acceptable. It reduced patient‐reported barriers, and referral time to specialized appointments and treatment initiation were within international recommended limits. Patient navigation may improve access to care for underserved patients in developing countries.

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          Breast cancer in Mexico: a growing challenge to health and the health system.

          Breast cancer is a major public health issue in low-income and middle-income countries. In Mexico, incidence and mortality of breast cancer have risen in the past few decades. Changes in health-care policies in Mexico have incorporated programmes for access to early diagnosis and treatment of this disease. This Review outlines the status of breast cancer in Mexico, regarding demographics, access to care, and strategies to improve clinical outcomes. We identify factors that contribute to the existing disease burden, such as low mammography coverage, poor quality control, limited access to diagnosis and treatment, and insufficient physical and human resources for clinical care. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Is Open Access

            Health system delay and its effect on clinical stage of breast cancer: Multicenter study

            BACKGROUND The objective of this study was to determine the correlation between health system delay and clinical disease stage in patients with breast cancer. METHODS This was a cross‐sectional study of 886 patients who were referred to 4 of the largest public cancer hospitals in Mexico City for the evaluation of a probable breast cancer. Data on time intervals, sociodemographic factors, and clinical stage at diagnosis were retrieved. A logistic regression model was used to estimate the average marginal effects of delay on the probability of being diagnosed with advanced breast cancer (stages III and IV). RESULTS The median time between problem identification and the beginning of treatment was 7 months. The subinterval with the largest delay was that between the first medical consultation and diagnosis (median, 4 months). Only 15% of the patients who had cancer were diagnosed with stage 0 and I disease, and 48% were diagnosed with stage III and IV disease. Multivariate analyses confirmed independent correlations for the means of problem identification, patient delay, health system delay, and age with a higher probability that patients would begin cancer treatment in an advanced stage. CONCLUSIONS In the sample studied, the majority of patients with breast cancer began treatment after a delay. Both patient delays and provider delays were associated with advanced disease. Research aimed at identifying specific access barriers to medical services is much needed to guide the design of tailored health policies that go beyond the promotion of breast care awareness and screening participation to include improvements in health services that facilitate access to timely diagnosis and treatment. Cancer 2015;121:2198–2206.
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              Patient Barriers to Follow-Up Care for Breast and Cervical Cancer Abnormalities

              Women with breast or cervical cancer abnormalities can experience barriers to timely follow-up care, resulting in delays in cancer diagnosis. Patient navigation programs that identify and remove barriers to ensure timely receipt of care are proliferating nationally. The study used a systematic framework to describe barriers, including differences between African American and Latina women; to determine recurrence of barriers; and to examine factors associated with barriers to follow-up care.
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                Author and article information

                Journal
                The Oncologist
                The Oncol
                Alphamed Press
                1083-7159
                1549-490X
                March 29 2019
                September 2019
                November 29 2018
                September 2019
                : 24
                : 9
                : 1195-1200
                Affiliations
                [1 ]Department of Hemato‐Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
                [2 ]Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico City Mexico
                [3 ]National Cancer Institute Rockville Maryland USA
                [4 ]Ajusco Medio General Hospital Dra. Obdulia Rodríguez Rodríguez Mexico City Mexico
                [5 ]Global Cancer Institute, Massachusetts General Hospital Cancer Center, Harvard Medical School Boston Massachusetts USA
                Article
                10.1634/theoncologist.2018-0133
                6738287
                30498134
                3654cf83-dd09-43c8-b254-8c63869ebba5
                © 2019

                http://onlinelibrary.wiley.com/termsAndConditions#vor

                http://doi.wiley.com/10.1002/tdm_license_1.1

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